No abstract available.
Progeria*

Frozen shoulders improve mostly by the conservative management, such as medication therapy and positive physical therapy. Despite the vast majority regain motion and have reduced pain with gentle but persistent exercises, patients do not always spontaneously recover motion. Arthroscopic manipulation may be recommanded in patients whose symptoms last more than 6 months or when the conservative treatment fails and severe stiffness is primarily originated. Nineteen cases of frozen shoulder underwent arthroscopic manipulation under the general anesthesia from February, 1990 to February, 1992. All but one case had shoulder pain and 13 cases(68.4%) had trivial trauma history at the time of symptom onset. One of the chief complaint was the limitation of motion; abduction: 19 cases, external rotation: 17 cases, flexion: 13 cases, extension: 11 cases, internal rotation: 8 cases and adduction: 7 cases. Average abduction range at the time of admission was 63.9°. In the average 23 months follow up(15 months to 3 year 2 months), painless was shown in 13 cases and significantly decreased pain in 6 cases, and all the patients were satisfactory with the results. The range of the abduction motion was changed from 64° to nearly normal. All of the patients improved by 1 month to 4 months, average 2.9 months. We propose arthroscopic manipulation could be recommended in the treatment of frozen shoulder if an appropriate conservative treatment is not effective.
Anesthesia, General ; Bursitis ; Exercise ; Humans ; Shoulder Pain ; Shoulder

BACKGROUND: Monocytes/macrophages play a central role in determining the host response during Gram-negative infection through secretion of a variety of mediators after stimulation of LPS. Even though cytokine production has been shown to play an important role in host defense during sepsis cytokine release may also lead to tissue injury. Thus, regulation of macrophage response to LPS is critical for host survival during Gram-neg-alive sepsis. In animals exposed to nonlethal doses of endotoxin a characteristic hyporesponsiveness to subsequent administration of endotoxin has been observed. This phenomenon was knowm as 'LPS tolerance'. However, little information is availavble regarding the underlying mechanism of U)S tolerance. METHOD: Peripheral blood monocyte(PBMC) was isolated from peripheral blood of normal volunteers by adhesion purification method. To evaluate conditions to obtain LPS tolerance. preculture was carried out with LPS at 10ng/ml for 24 hours. For stimulation culture plates were washed two times and were stimulated with LPS at 1ng/ml for 4, 6 and 26 hours. To assess the underlying mechanisms of LPS tolerance, autologous serum, PMA, anti-CD14 Ab, Indomethacin or PGF2 were added to preculture solution respectively. Cytokine concentrations in culture supernatants were measured using ELISA for TNF-α and IL-8 and mRNA of TNF-α and IL-8 were determined by Northern blot analysis. RESULTS: The exposure of PBMC to low dose of LPS suppressed the cytokine production and mRNA expression of TNF-α, but not IL-8. Anti-CDl4 Ab partially recovered production of TNF-α which was suppressed by preculture with low dose LPS. The preculture with PMA induces US tolerance, as preculture with low dose LPS. CONCLUSION: LPS tolerance to TNF-α is regulated pretranslationally and is influenced by protein kinase C pathway and CD14.
Animals ; Blotting, Northern ; Dinoprost ; Enzyme-Linked Immunosorbent Assay ; Healthy Volunteers ; Indomethacin ; Interleukin-8* ; Macrophages ; Monocytes* ; Protein Kinase C ; RNA, Messenger ; Sepsis ; Tumor Necrosis Factor-alpha*

Primary squamous cell carcinoma of the colon is very rare and its incidence is 0.025% to 0.05% among all colon cancers. We report a case of primary squamous cell carcinoma of the sigmoid colon in a 65year-old man. He had bowel habit change and hematochezia for 3 months. Colonoscopy with biopsy and left inguinal lymph node biopsy revealed squamous cell carcinoma. We confirmed the diagnosis of primary squamous cell carcinoma of the sigmoid colon with lymph node metastasis by diagnostic criteria. The patient was discharged against advice and expired.
Biopsy ; Carcinoma, Squamous Cell* ; Colon ; Colon, Sigmoid* ; Colonic Neoplasms ; Colonoscopy ; Diagnosis ; Gastrointestinal Hemorrhage ; Humans ; Incidence ; Lymph Nodes ; Neoplasm Metastasis

BACKGROUND: It is well known that when macrophages are stimulated with endotoxin, they produce a wide variety of cytokine mediators, including TNF-α and IL-1β. However, there is an alterationnin the macrophages responsiveness when they are challenged with repeated bouts of endotoxin, termed 'endotoxin tolerance' which is regarded as a self-protective phenomenon from continuous stimulation. In this study, endotoxin tolerance in the peripheral blood monocytes of sepsis patients was evaluated. METHODS: Fourteen patients with organism-documented sepsis were included. The severity of illness was evaluated by APACHE IIscore. Peripheral blood monocytes were isolated from the patients and diluted to 1×105/well. After stimulation with endotoxin(LPS of E. coli O114:B4, 100 ng/ml), they were incubated at 37℃ in 5% CO2 incubator for 24 hours. Supernatant was collected for the measurement of TNF-αand IL-1β with ELISA method. Peripheral blood monocytes of seven healthy volunteers were used as control. RESULTS: The APACHE IIscore(mean±SD) of the patients at the time of blood sampling was 12.2±5.7. The primary infection foci were urinary tract infection, pneumonia, subacute bacterial endocarditis, and catheter related infection, etc. The causative organisms were gram negative rods(10 cases), gram positive cocci(6 cases) with two cases of mixed infection. Serum TNF-α could be measured in 4 cases with 29.9±27.7 pg/ml. Serum IL-1β was measureable in only one patient. The TNF-α level of supernatant of cultured peripheral blood monocytes was 2,703±2,066 pg/ml in patients and 2,102±1,914 pg/ml in controls. The IL-1β level of supernatant was 884±1,050 pg/ml in patients and 575±558 pg/ml in controls. There was no difference of TNF-α and IL-1β level between patients and controls. CONCLUSION: We cannot prove the phenomenon of endotoxin tolerance in this study. Future study needs to be focused on the more severe sepsis patients who were taken for sampling earlier. Addition of serum to the culture medium could be an another valuable option for the success of this study.
APACHE ; Catheters ; Coinfection ; Endocarditis, Subacute Bacterial ; Enzyme-Linked Immunosorbent Assay ; Healthy Volunteers ; Humans ; Incubators ; Macrophages ; Monocytes ; Pneumonia ; Sepsis* ; Tumor Necrosis Factor-alpha* ; Urinary Tract Infections

Sarcoidosis is a multisystem granulomatous disorder commonly affecting young adults. Diagnosis is confirmed by evidence of non-caseating granuloma in more than one organ. A case is presented where the diagnosis was made on a bone marrow biopsy, the first case in Korea. A 54-year-housewife was admitted because of multiple variable sized, skin papules and macules, who showed pancytopenia and evidence of liver cirrhosis on ultrasound. We performed skin biopsy and bone marrow biopsy, which showed non-caseating granulomas. The chest CT, opthalmologic examination was performed and showed the involvement of sarcoidosis of mediastinal lymph nodes and uvea. Multiple joints of both hands and feet also seemed to be involved in view of simple X-ray. By this case, we emphasize the significance of bone marrow biopsy in the sarcoidosis with pancytopenia.
Biopsy ; Bone Marrow* ; Diagnosis ; Foot ; Granuloma ; Hand ; Humans ; Joints* ; Korea ; Liver Cirrhosis ; Liver* ; Lymph Nodes ; Pancytopenia ; Sarcoidosis* ; Skin* ; Tomography, X-Ray Computed ; Ultrasonography ; Uvea* ; Young Adult

BACKGROUND: Endotoxin, the component of outermembrane of gram negative organism, plays an important role in the initiation and amplification of inflammatory reaction by its effects on inflammatory cells. Until recently, there have been continuing efforts to delinate the mechanisms of the signal trasduction pathway of endotoxin stimuli on inflammatory cells. By uncovering the mechanisms of signal transduction pathway of endotoxin stimuli, we can expect to have tools to control the excessive inflammatory responses which sometimes may be fatal to the involved host. It was generally accepted that endotoxin exerts its inflammatory effects through inflammatory cytokines that are produced by endotoxin-stimulated inflammatory cells and there were some reports on the importance of protein kinase C and protein tyrosine kinase activation in the production of inflammatory cytokines by endotoxin. So we evaluated the effect of pretreatment of protein kinase C inhibitors (H7, Staurosporin) and protein tyrosine kinase inhibitors(Herbimycin, Genistein) on the endotoxin-stimulated cytokines(IL-8 & TNF-alpha) mRNA expression. METHOD: Peripheral blood monocytes were isolated from healthy volunteers by Ficoll-Hypaque density gradient method and purified by adhesion to 60mm Petri dishes. Endotoxin(LPS 100ng/ml) was added to each dishes except one control dish, and each endotoxin-stimulated dishes was preincubated with H7, Staurosporin(protein kinase C inhibitor), Herbimycin or Genistein(protein tyrosine kinase inhibitor) respectively except one dish. Four hours later the endotoxin stimulation, total RNA was extracted and Northern blot analysis for IL-8 mRNA and TNF-alpha mRNA was done. RESULT: Endotoxin stimulation increased the expression of IL-8 mRNA and TNF-alpha mRNA expression in human peripheral blood monocyte as expected and the stimulatory effect of endotoxin on TNF-alpha mRNA expression was inhibited by protein kinase C inhibitors(H7, Staurosporin) and protein tyrosine kinase inhibitors (Herbimycin, Genistein). The inhibitory effect of each drugs was increased with increasing concentration. The stimulatory effect of endotoxin on IL-8 mRNA was also inhibited by H7 and protein tyrosine kinase inhibitors (Herbimycin, Genistein) dose-dependently but not by Staurosporin. CONCLUSION: Protein kinase C and protein tyrosine kinase are involved in the endotoxin induced signal transduction pathway in human peripheral blood monocyte.
Blotting, Northern ; Cytokines ; Healthy Volunteers ; Humans ; Interleukin-8 ; Monocytes* ; Phosphotransferases ; Protein Kinase C* ; Protein Kinases* ; Protein-Tyrosine Kinases* ; RNA ; RNA, Messenger ; Signal Transduction* ; Tumor Necrosis Factor-alpha

Pulmonary Embolism can develop in variable conditions, and presents with nonspecific symptoms and signs. If diagnosis is delayed, it can be resulted in catastrophic results. Therefore, early diagnosis and adequate treatment is crucial in Pulmonary Embolism. Lung Perfusion Scan is useful screening test. Negative result can exclude pulmonary embolism, But, perfusion defects don't always mean pulmonary embolism. To find the better methods of interpretation of king perfusion scan and To evaluate the clinical course and outcomes of the patients, in whom pulmonary embolism was suspected by lung perfusion scan, we reviewed the clinical records of 49 cases suspected by lung perfusion scan at Seoul National University Hospital during the period of January, 1995 to July, 1996. The results are as follows. First impression of cases in which PE was present at time of admission were pulmonary embolism (63%), heart diseases (26%), and pneumonia (11%) in orders. Underlying diseases of cases in which PE developed during admission were malignancy (36.5%), 10-I (22.7%), sepsis (13.7%), and SLE (9.1%) in orders. The predisposing factors were operation (20%), cancer (16%), immobility (16%), connective tissue disease (16%), heart dis. (10%), old age (10%), and preg/pelvic dis. (8%) The results of lung perfusion scan were HPPE 40cases(26.8%), IPPE 21 cases(14.1%), LPPE 88 cases(59.l %) and cases(%) of treatment in these cases were HPPE 34 cases(85%), IPPE 9 cases(42,9%), IPPE 0 case(0.0%). Treatments were heparin and warfarin (69.5%), heparin alone (8.2%), warfarin alone (2.0%), embolectomy(4.1%), thrombolytics (20%), IVC filter (2.0%), and no treatment (12.2%) In 34 cases (694%), follow up could be done, and 5 cases were recurred (10.2%). The causes of recurrence was incomplete anticoagulant therapy (3 cases) 2rnd recurrence of predisposing factor (2 cases). Expired case due to pulmonary embolism was one who was expired just before trial of thrombolytie therapy. CONCLUSION: Efforts should be made to shorten the interval from onset of Sx to Dx, ie, high index of suspision.
Causality ; Connective Tissue Diseases ; Diagnosis ; Early Diagnosis ; Follow-Up Studies ; Heart ; Heart Diseases ; Heparin ; Humans ; Lung* ; Mass Screening ; Perfusion* ; Pneumonia ; Pulmonary Embolism* ; Recurrence ; Seoul ; Sepsis ; Warfarin

Although pulmonary artery aneurysms are a rare vascular anomaly, they are seen in a wide variety of conditions, such as congenital heart disease, infection, trauma, pulmonary hypertension, cystic medial necrosis and generalized vasculitis. To our knowledge, mycotic aneurysms caused by pulmonary actinomycosis have not been reported in the radiologic literature. Herein, a case of pulmonary actinomycosis complicated by mycotic aneurysm is presented. On CT scans, this case showed focal aneurysmal dilatation of a peripheral pulmonary artery within necrotizing pneumonia of the right lower lobe, which was successfully treated with transcatheter embolization using wire coils.
Actinomycosis/*complications ; Aged ; Aneurysm, Infected/*etiology/*radiography/therapy ; Embolization, Therapeutic ; Human ; Male ; Pneumonia, Bacterial/*complications ; *Pulmonary Artery ; Treatment Outcome

OBJECTIVES: Visualization of the left atrial appendage(LAA) by the transesophageal echocardiography(TEE) is excellent, but it is difficult to visualize the LAA by the modified parasternal short-axis view(MPSA) in transthoracic echocardiography(TTE). We studied to determine the usefulness of the apical horizontal view(AHV) abtained by the apical rotation method of the transducer for the detection of the LAA. METHODS: We studied the MPSA and AHV in 602 patients, The LAA was observed during diastole of the LAA. We obtained an apical horizontal view by 45 degree clockwise rotation of the transducer from the apical 2 chamber view and compared with the visualization of the LAA in AHV and MPSA. RESULTS: Among 602 patients, LAA could not be visualized in 88(14.6%) because of a poor echo-window. LAA was more clearly visualized in 222 patients by the AHV than the MPSA and 56 patients by the MPSA than the AHV. LAA was same degree visualization in patients by the AHV and MPSA. In male and female, more than 55 ages and less than 55 ages, visualization of inner margin of the LAA by the AHV was more clear than by the MPSA. CONCLUSION: The AHV was a useful, noninvasive and reproducible method for the visualization of the LAA.
Atrial Appendage* ; Diastole ; Female ; Humans ; Male ; Transducers*